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Arq. bras. med. vet. zootec. (Online) ; 73(3): 647-652, May-June 2021. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1278370


The treatment of fractures from the thoracic limb in giant anteaters is extremely challenging. Unfamiliar and peculiar anatomical characteristics, robust musculature and the imminent need for an early return to limb function highlight such challenges. The objective of this report was to describe the successful use of anatomical osteosynthesis with a robust locking compression plate in a humeral fracture of an adult giant anteater. The patient was rescued on the highway after being run over and presented for treatment at the Veterinary Teaching Hospital. Surgical stabilization was performed using a craniomedial approach to the humerus, using a customized broad 3.5mm locking compression plate. The patient presented early limb support at 24 hours postoperatively. Radiographic monitoring was performed at 30, 60 and 90 days postoperatively, and bone healing was observed without any complications. It is concluded that the treatment of humerus fractures in giant anteaters requires robust fixation. The use of a reinforced locking compression plate system proved to be effective and adequate to the mechanical load that an adult individual of this species needs for early use of the thoracic limb and, at the same time, efficient in controlling interfragmentary movement, which allowed fracture consolidation.(AU)

O tratamento das fraturas do membro torácico dos tamanduás-bandeira (Myrmecophaga tridactyla) é extremamente desafiador. Características anatômicas pouco familiares e peculiares, musculatura muito desenvolvida e necessidade iminente de retorno precoce à função do membro destacam tais desafios. Objetivou-se, neste relato, descrever a utilização com sucesso da osteossíntese anatômica com placa bloqueada robusta em fratura umeral de um tamanduá-bandeira. O paciente foi resgatado em rodovia após atropelamento e atendido no Hospital Veterinário Universitário. Após sedação e avaliação física completa, foi realizado exame radiográfico, o qual revelou fratura completa oblíqua curta em diáfise média de úmero esquerdo. A estabilização cirúrgica foi realizada por abordagem craniomedial ao úmero, utilizando-se placa bloqueada (LCP) do sistema 3,5mm customizada. O paciente apresentou apoio precoce do membro com 24 horas de pós-operatório. Realizou-se acompanhamento radiográfico aos 30, 60 e 90 dias, sendo observada união clínica sem quaisquer complicações. Conclui-se que o tratamento das fraturas do úmero em tamanduás-bandeira exige robustez na fixação. A utilização de sistema reforçado de placa bloqueada mostrou-se efetiva e adequada à carga mecânica de que um indivíduo adulto dessa espécie necessita para uso precoce do membro torácico e, ao mesmo tempo, eficiente no controle da movimentação interfragmentária, o qual permitiu consolidação da fratura.(AU)

Animals , Fracture Healing , Eutheria/surgery , Fracture Fixation, Internal/methods , Fracture Fixation, Internal/veterinary , Humeral Fractures/surgery , Humeral Fractures/veterinary , Bone Plates/veterinary , Animals, Wild/surgery
Chinese Medical Journal ; (24): 390-397, 2021.
Article in English | WPRIM | ID: wpr-878069


BACKGROUND@#The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs. triceps-sparing approach for patients with distal humerus intercondylar fracture.@*METHODS@#The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications.@*RESULTS@#Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69-2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: -2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: -28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: -18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49-7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach.@*CONCLUSIONS@#This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Elbow Joint/surgery , Fracture Fixation, Internal , Humans , Humeral Fractures/surgery , Humerus , Olecranon Process/surgery , Osteotomy , Range of Motion, Articular , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-921905


OBJECTIVE@#To investigate clinical effects of intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children.@*METHODS@#From January 2013 to July 2018, 18 children with intercondylar fracture of humerus were treated by operation, including 13 males and 5 females aged from 3 to 12 years old with an average age of (8.50±2.57) years old. According to Toniolo & Wilkinson classification, 8 children were typeⅠand 10 children were typeⅡ. During the operation, closed reduction and internal fixation were performed under the monitoring of intraoperative radiography, open reduction and internal fixation were performed in necessity. Mayo score of elbow joint was used to evaluate clinical effect at 6 months after operation.@*RESULTS@#All children were underwent arthrography monitoring during operation, 5 children were treated with closed reduction and internal fixation for intraoperative arthrography found no fracture of articular cartilage, 11 children by closed reduction and internal fixation because of fracture of articular cartilage involving the joint space with displacement less than 2 mm, and 2 children by closed or open reduction and internal fixation for fracture of articular cartilage surface with displacement above 2 mm, which 1 child with smooth of joint surface was performed closed reduction and internal fixation, 1 child without smooth of joint surface and displacement above 2 mm was performed open reduction and internal fixation. All children were followed up from 8 to 26 months with an average of (20.28±4.40) months. All factures were healed from 6 to 9 weeks with an average of (7.33±0.77) weeks. Postoperative Mayo score of elbowjoint at 6 months was (89.44±11.36), and 12 patients got excellent results, 5 good and 1 poor. One patient occurred partial limitation of flexion or extension of elbow joint. No elbow deformity and other complications occurred.@*CONCLUSION@#The treatment of intercondylar fracture of humerus in children under monitoring of intraoperative radiography could reduce opertaion injuries and complications, confirm the reduction effect of articular surface of cartilage in time and clearly, and promote recovery of elbow joint function.

Arthrography , Child , Child, Preschool , Female , Fracture Fixation, Internal , Humans , Humeral Fractures/surgery , Humerus , Male , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879458


OBJECTIVE@#To explore clinical effectiveness and safety of ultrasound-guided closed reduction and K-wires internal fixation in treating of Kilfoyle Ⅱand Ⅲ medial condylar fracture of humerus in children.@*METHODS@#Clinical data of 32 children with medial condylar fracture of humerus treated with closed reduction and internal fixation with K-wires under the guidance of ultrasound were retrospectively analyzed from January 2014 to August 2019, including 23 males and 9 females, age ranged from 3.2 to 12.8 years old with an average of (8.3±2.1) years old;According to classification of Kilfoyle, 12 patients classified to typeⅡ and 20 patients were type Ⅲ;5 patients combined with elbow dislocation;the time from injury to operation ranged from 1 to 5 days with an average of (3.1±1.3) days. Radiological evaluation of treatment results and complications were observed. At the final follow up, Mayo elbow performance score(MEPS) was used to evaluate elbow function. And humerus-ulna angle on the affect side and healthy side were measured and compared.@*RESULTS@#All patients were followed up from 8 to 26 months with an average of(19.3±5.5) months. All fractures were healed well, the healing time ranged from 4 to 6 weeks with an average of (4.5±0.5) weeks. No infection, vascular and nerve injury, bone nonunion, trochlear necrosis, cubitus varus or valgus deformity were occurred. According to Mayo scoring, all patients were assessed as excellent. There was no significant difference in angle of humerus-ulna between affectedside (9.5±3.6)° and healthy side (9.1±3.5)°, and no difference in MEPS scores between affected side(95.3±2.5) and healthy side(96.3±2.2)(@*CONCLUSION@#For Kilfoyle typeⅡand Ⅲ medial condylar fracture of humerus in children, closed reduction and internal fixation with K-wire under ultrasound guidance is a safe and effective method, and could promote in further.

Bone Wires , Child , Child, Preschool , Female , Fracture Fixation, Internal , Humans , Humeral Fractures/surgery , Humerus , Male , Retrospective Studies , Treatment Outcome , Ultrasonography, Interventional
Article in Chinese | WPRIM | ID: wpr-879394


OBJECTIVE@#To compare clinical effect of cannulated screw and bone plate for the treatment of humeral fracture of greater tuberosity.@*METHODS@#From January 2010 to January 2020, clinical trial literatures on the treatment of humeral tuberosity fractures with cannulated screw and bone plate were searched by PubMed, EMbase, Cochrane Library, Wanfang, CNKI, CBM Database, VIP Database and other databases. Independent literature screening, quality evaluation, and data extraction were performed according to inclusion and exclusion criteria. Revman5.2 software was used to perform Meta analysis.@*RESULTS@#Totally 5 clinical randomized controlled trials and 12 cohort studies were selected, including 1 068 patientsin which 559 patients were treated by cannulated screw internal fixation and 509 patients treated by bone plate internal fixation. Meta analysis resluts showed that there were satistical differences in operation time[MD=-23.03, 95% CI(-29.69, -16.36), @*CONCLUSION@#Compared with bone plate, cannulated screw for the treatment of humeral fracture of greater tuberosity has advantages of shorter opertaion time, less blood loss, shorter hospital stay, lower incidence rate of postopertaive infection, and more benefit for fracture healing.

Bone Plates , Bone Screws , Fracture Fixation, Internal , Humans , Humeral Fractures/surgery , Humerus , Randomized Controlled Trials as Topic , Treatment Outcome
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 568-574, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353962


Introducción: La fractura diafisaria de húmero es frecuente y, en la actualidad, se privilegia el tratamiento quirúrgico. La consolidación en mala rotación puede causar un deterioro de la función y artrosis a largo plazo. Con las técnicas mínimamente invasivas, es difícil manejar la rotación intraoperatoria al no tener una visión directa de la reducción fracturaria. Objetivo: Describir criterios radiográficos para la reducción rotatoria en las fracturas diafisarias de húmero. Materiales y métodos: Estudio retrospectivo de radiografías de húmero comparando criterios radiográficos del húmero distal entre radiografías con rotación interna (sin retroversión proximal) y rotación externa (con retroversión fisiológica). Criterios estudiados: sobreproyección del epicóndilo lateral por sobre el capitellum >50%, esclerosis del borde inferior de la fosa olecraneana, esclerosis del borde lateral de la fosa olecraneana y asimetría de la fosa olecraneana. Resultados: El 97% de las 200 radiografías estudiadas cumplió con los criterios de inclusión y exclusión. Sobreproyección del epicóndilo por sobre el capitellum: 83,3% de los casos; esclerosis del borde inferior de la fosa olecraneana: 30%, esclerosis del borde lateral de la fosa olecraneana: 86,6% y asimetría: 80% de ellas. Todos los criterios con significancia estadística (p <0,001). Al analizar los tres signos positivos en conjunto, la sensibilidad fue del 70% y la especificidad, del 98%; valor predictivo positivo 95,5% y valor predictivo negativo 84,5%. Conclusiones: La rotación humeral correcta es difícil de reproducir en las cirugías mínimamente invasivas, en pacientes con una fractura diafisaria. Describimos cuatro criterios radiográficos que permiten inferir una correcta rotación humeral. Nivel de Evidencia: III

Introduction: Humeral shaft fractures are frequent and surgical treatment is currently favored. Consolidation in malrotation is a complication that can lead to impaired function and long-term osteoarthritis. In minimally invasive techniques, it is difficult to manage intraoperative rotation as there is no direct view of the fracture reduction. Objective: To describe radiological criteria for rotational reduction in humeral shaft fractures. Materials and methods: Retrospective study of humerus radiographs comparing radiological criteria of the distal humerus between radiographs with internal rotation (without proximal retroversion) and radiographs with external rotation (with physiological retroversion). Criteria studied: Overprojection of the lateral epicondyle over the capitellum of more than 50%; sclerosis of the lower border of the olecranon fossa (OF); sclerosis of the lateral border of the OF and asymmetry of the OF. Results: 200 radiographs were studied; 97% met the inclusion and exclusion criteria. Overprojection of the epicondyle over the capitellum was found in 83.3% of the cases. Sclerosis of the inferior border of the OF in 30%, sclerosis of the lateral border of the OF in 86.6%, and asymmetry of OF in 80%. All criteria with statistically significant (p<0.001). When analyzing the 3 positive signs, we found a sensitivity of 70% and a specificity of 98%. The positive predictive value was 95.5% and the negative predictive value was 84.5%. Conclusions: Correct humeral rotation is difficult to reproduce when performing minimally invasive surgeries in patients with a diaphyseal fracture. We describe 4 radiological criteria that allow inferring a correct humeral rotation. Level of Evidence: III

Radiography , Diaphyses , Fracture Fixation, Intramedullary , Humeral Fractures/surgery
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1142104


Introducción: Las fracturas del húmero distal corresponden al 2% de todas las fracturas. Son los pacientes más añosos, los que presentan mayor desafío terapéutico. Suelen presentarse con huesos osteoporóticos, lo que conlleva a producir fracturas con mayor conminución articular y metafisaria; así como también dificultar una fijación estable y rígida de las mismas, que permita una movilidad precoz. Estas características generan controversia a la hora de elegir el tratamiento adecuado. El objetivo de este estudio es revisar la bibliografía de la última década, acerca de cuál es la mejor opción terapéutica para las fracturas de húmero distal en pacientes añosos. Materiales y métodos: Se realizó una búsqueda sistematizada a través de los buscadores electrónicos PubMed y Timbó en agosto 2019. La búsqueda llego a un total de 475 artículos, de los cuales se seleccionaron 24 según criterios de inclusión y exclusión. Discusión: La mayoría de los estudios analizados son estudios de serie de casos retrospectivos. En los trabajos revisados, existen fracturas tanto extra como intra-articulares. Se analizaron los resultados de los distintos tratamientos realizados según parámetros clínicos, scores funcionales y complicaciones. Conclusiones: El tratamiento conservador es una opción válida para aquellos pacientes en los que el terreno no permita una intervención quirúrgica. Para las fracturas tipo extra-articulares y parcialmente articulares, la reducción abierta y fijación interna es el tratamiento de elección. Para las fracturas articulares completas, no hay diferencias significativas en cuanto a scores utilizados entre la reducción abierta y fijación interna con la artroplastia de codo. Faltan estudios prospectivos que comparen ambos tratamientos.

Introduction: Distal humerus fractures account for 2% of all fractures. It is the elderly patients who present the greatest therapeutic challenge. Osteoporotic bones, more common in this population, lead to the production of fractures with greater joint and metaphyseal comminution. As a result, stable and rigid fixation becomes more difficult, hindering early mobility. These characteristics generate controversy when choosing the appropriate treatment. The aim of this study is to review the literature of the last decade regarding the best therapeutic option for distal humerus fractures in elderly patients. Methods: A systematized search was performed through the electronic search engines PubMed and Timbó in august 2019. The search reached a total of 475 articles, of which 24 were selected according to inclusion and exclusion criteria. Discussion: Most of the studies analyzed are retrospective case series studies. In the articles reviewed, there are both extra and intra-articular fractures. The results of the different treatments performed were analyzed according to clinical parameters, functional scores and complications. Conclusions: Conservative treatment is a valid option for those patients where the terrain does not allow surgical intervention. For extra-articular and partial-articular fractures, open reduction and internal fixation is the treatment of choice. For complete articular fractures, there are no significant differences in scores used between open reduction and internal fixation and elbow replacement. There is a lack of prospective studies comparing both treatments.

Introdução: Fraturas do úmero distal correspondem a 2% de todas as fraturas. São os pacientes mais idosos os que apresentam maior desafio terapêutico. Geralmente apresentam-se com ossos osteoporóticos, o que implica produzir fraturas com maior cominuição articular e metafisária; assim como também dificultar uma fixação estável e rígida das mesmas, que permita uma mobilidade precoce. Estas características geram controvérsia na escolha do tratamento adequado. O objetivo deste estudo é rever a bibliografia da última década, sobre qual é a melhor opção terapêutica para fraturas de úmero distal em pacientes idosos. Materiais e métodos: Foi realizada uma pesquisa sistematizada através dos buscadores eletrônicos Pubmed e Timbó em agosto 2019. A pesquisa chegou a um total de 475 artigos, dos quais 24 foram selecionados segundo critérios de inclusão e exclusão. Discussão: A maioria dos estudos analisados são estudos de série de casos retrospectivos. Nos trabalhos revisados, existem fraturas tanto extra como intra-articulares. Foram analisados os resultados dos diferentes tratamentos realizados segundo parâmetros clínicos, scores funcionais e complicações. Conclusões: O tratamento conservador é uma opção válida para os pacientes em que o terreno não permita uma intervenção cirúrgica. Para fraturas tipo extra-articulares e parcialmente articulares, a redução aberta e fixação interna é o tratamento de escolha. Para fracturas articulares completas, não há diferenças significativas em termos de scores utilizados entre a redução aberta e a fixação interna com artroplastia do cotovelo. Faltam estudos prospectivos que comparem os dois tratamentos.

Humans , Male , Female , Aged , Aged, 80 and over , External Fixators/adverse effects , Arthroplasty, Replacement, Elbow/adverse effects , Conservative Treatment/adverse effects , Fracture Fixation/adverse effects , Humeral Fractures/surgery , Humeral Fractures/therapy , Treatment Outcome , Ilizarov Technique/adverse effects , Closed Fracture Reduction/adverse effects , Open Fracture Reduction/adverse effects , Fracture Fixation, Internal/adverse effects
Rev. medica electron ; 42(4): 2086-2093, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1139298


RESUMEN Se presentó el caso de un adolescente que sufrió fractura por estrés del húmero izquierdo, mientras lanzaba en un partido de béisbol. Las fracturas de húmero por estrés son infrecuentes. Generalmente ocurre en los atletas que practican deportes de lanzamiento, es más frecuente en los lanzadores de béisbol amateurs de poca experiencia. Esta lesión es debida a la tracción muscular incoordinada y fuerza de torsión cuando la pelota es lanzada, asociada a la fatiga física. Puede ocurrir a nivel de los tercios medio y superior del húmero, entre las inserciones del deltoides y el pectoral mayor, así como en el tercio distal. Es común la presencia de dolor poco antes de producirse la fractura. Se enfatizó en la importancia de tener presente la posibilidad de presentación de este tipo de fractura en los atletas que practican deportes de lanzamientos, así como tener presente además las complicaciones que puedan presentarse a partir de este tipo de lesión. Se analizaron los datos recogidos en la historia clínica del paciente. Es importante pensar en este tipo de lesión, pues en ocasiones el cuadro clínico no es evidente. Se señaló además la necesidad de realizar un estricto seguimiento del paciente ante la posibilidad de lesión del nervio radial (AU).

ABSTRACT The authors present the case of a teenager who suffered left humerus fracture due to stress while he was pitching a baseball game. Humerus fractures caused by stress are infrequent. They commonly occur in athletes practicing throwing sports, being more frequent in amateur baseball pitchers with little experience. This lesion is due to uncoordinated muscular traction and torsion strength when the ball is thrown, all associated to physical fatigue. It can happen at the level of the medial and upper third of the humerus, between the insertions of deltoids and pectoral major muscles, and also in the distal third. The presence of pain is common a little before the fracture happens. The authors emphasize in the importance of taking into account the possibility of this kind of fracture occurring in athletes practicing throwing sports, and also the complications appearing after this kind of lesion. Data collected from the patient?s clinical record were analyzed. It is important to think in this kind of lesion because sometimes clinical characteristics are not evident. It was also pointed out the necessity of performing a strict follow-up of the patient given the possibility of radial nerve lesion (AU).

Humans , Male , Adult , Athletic Injuries/diagnosis , Fractures, Stress/diagnosis , Humeral Fractures/diagnosis , Athletic Injuries/surgery , Athletic Injuries/complications , Athletic Injuries/rehabilitation , Fractures, Stress/surgery , Fractures, Stress/complications , Fractures, Stress/rehabilitation , Fatigue/complications , Humeral Fractures/surgery , Humeral Fractures/pathology
Acta ortop. mex ; 34(2): 91-95, mar.-abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1345094


Resumen: Introducción: Las fracturas supracondíleas representan la causa más frecuente de las lesiones del codo pediátrico (64% de la población en niños menores de ocho años). Estas fracturas pueden presentar complicaciones como: A) complicaciones previas al tratamiento: 1) neurológicas, 2) vasculares y 3) síndrome compartimental. B) complicaciones posteriores al tratamiento: 1) precoces en los primeros días tras el tratamiento: pérdida de reducción, complicaciones neurológicas, vasculares, síndrome compartimental, infección de las agujas de Kirschner, 2) complicaciones tardías en el tratamiento: deformidad angular, pérdida de movilidad, miositis osificante, necrosis avascular de la tróclea, entre otros. Objetivo: Determinar la frecuencia de las complicaciones en fracturas supracondíleas humerales en menores de ocho años. Material y métodos: Se realizó un estudio retrospectivo y observacional de cohorte en pacientes menores de ocho años en el período de Marzo de 2014 a Febrero de 2018. Resultados: Se obtuvieron 277 pacientes con los siguientes porcentajes: 3.97% presentó lesiones de cúbito varo; 1.44%, lesiones neurológicas previas al tratamiento quirúrgico; 1.44%, complicaciones neurológicas precoces al tratamiento; 0.72%, infecciones de agujas de Kirschner; 0.72%, cúbito valgo y 0.36% con pérdida de la movilidad. Conclusiones: La complicación más frecuente de las fracturas supracondíleas de húmero en este estudio fue cúbito varo y complicaciones neurológicas previas al tratamiento.

Abstract: Introduction: Supracondylar fractures represent the most frequent cause of pediatric elbow injuries, at 64%, in children under eight years old. These fractures can present complications such as: A) Complications prior to treatment: 1) neurological, 2) vascular and 3) compartment syndrome. B) Complications after treatment: 1) early, in the first days after treatment: loss of reduction, neurological, vascular, compartment syndrome, infection of Kirschner wires. 2) Late complications in treatment: Angular deformity, loss of mobility, ossifying myositis, avascular necrosis of the trochlea, others. Objective: To determine the frequency of complications in humeral supracondylar fractures in less than eight years. Material and methods: A retrospective, observational cohort study was conducted in patients under 8 years of age during the period of March 2014 to February 2018. Results: 277 patients were obtained with the following percentages: cubitus varus 3.97%, neurological lesions prior to surgical treatment 1.44%, early neurological complications to treatment 1.44%, infections of Kirschner needles 0.72%, cubitus valgus 0.72%, loss of mobility 0.36%. Conclusions: The most common complication of humerus supracondylar fractures in this study was cubitus varus and neurological complications prior to treatment.

Humans , Child , Reconstructive Surgical Procedures , Humeral Fractures/surgery , Humeral Fractures/complications , Bone Wires , Retrospective Studies , Range of Motion, Articular
Article in Chinese | WPRIM | ID: wpr-879332


OBJECTIVE@#To investigate clinical effect of closed reduction and radial parallel Kirschner wire internal fixation in treating Gartland Ⅲ supracondylar fracture of humerus in children.@*METHODS@#From May 2015 to October 2019, 72 children with Gartland Ⅲ supracondylar fracture of humerus were treated by closed reduction and radial parallel Kirschner wire internal fixation, including 52 males and 20 females, aged from 3 to 10 years old with an average of (5.4±1.3) years old;39 patients classified to Gartland ⅢA and 33 patients classified to Gartland Ⅲ B. Operation time, fracture healing time, and functional exercise time were observed, Flynn elbow joint function score was used to evaluate clinical effects.@*RESULTS@#All patients were followed up from 2 to 6 months with an average of (3.5±1.4) months. Operation time was 25~90 (37.8±10.4) min, fracture healing time was 28~45(38.8±9.4) days, functional exercise time was 22~60(36.9±11.2) days. No cubitus varus, iatrogenic neurovascular injury, reduction loss, compartment syndrome, infection or other complications occurred. According to Flynn elbow joint function score, 60 patients got excellent results, 10 good and 2 fair.@*CONCLUSION@#Closed reduction and radial parallel Kirschner wire internal fixation in treating Gartland Ⅲ supracondylar fracture of humerus in children has advantages of minimally invasive, stable fixation, shorter operation time, easy to remove internal fixation, and less complications.

Bone Wires , Child , Child, Preschool , Female , Fracture Fixation, Internal , Fracture Healing , Humans , Humeral Fractures/surgery , Humerus , Male
Article in Chinese | WPRIM | ID: wpr-879322


OBJECTIVE@#To investigate the effect of ultrasound guided reduction and exploration of ulnar nerve position and percutaneous crossed pin fixation for the treatment of displaced supracondylar fracture of the humerus in children.@*METHODS@#The clinical data of 45 patients with displaced supracondylar fracture of humerus from December 2017 to December 2018 were analyzed retrospectively, including 26 boys and 19 girls, ranging in age from 1 year and 3 months to 11 years and 4 months, with an average of 7.6 years old;44 cases of crashing injury, 1 case of falling injury;29 cases on the left side, 16 cases on the right side;12 patients classified to Gartland typeⅡand 33 patients classified to Gartlandtype Ⅲ. The operation was performed from 4 h to 7 d after injury, with an average of 2.5 d. There were no neurological and vascular injuries occurred in the children. Ultrasound was used to guide the fracture reduction of the child, and the cross-needle was fixed. In the medial needle insertion, the ulnar nerve position was detected by ultrasound to avoid damage to the ulnar nerve. The ulnar nerve state was observed during operation. The clinical function evaluation criteria of Flynn was used at the latest follow-up. The evaluation criteria was used to evaluate the functional and aesthetic characteristics of the elbow joints of the children, and to observe the complications such as ulnar nerve injury after operation.@*RESULTS@#Ultrasound was used to detect the fracture from the medial side of the elbow, the lateral aspect of the elbow and the sagittal plane of the elbow. The position of the ulnar nerve could be clearly explored to avoid ulnar nerve injury when the needle was inserted inside. All children were followed up, and the duration ranged from 6 to 12 months, with an average of 9 months. None of the patients had a loss of repositioning and the fractures healed. The healing time ranged from 4 to 6 weeks, with an average of 5 weeks. At the latest follow-up, according to Flynn's evaluation criteria:compared with the healthy side, 41 patients with flexion and extension limitation were 0° to 5°, clinically evaluated as excellent;3 patients with flexion and extension limitation were 6° to 10°, clinically evaluated as good;1 patient with flexion and extension limitation was 11° to 15°, clinically evaluated as acceptable. Compared with the healthy side, 40 patients lost 0° to 5°of the angle, and 5 patients lost 6° to 10°of the angle. There were no complications such as ulnar nerve injury and cubitus varus.@*CONCLUSION@#Although ultrasound-guided treatment of displaced supracondylar fracture of the humerus in children has higher requirements for the operator at present, because of its advantages of clear development, portability, effectiveness and no impact on health, it could clearly explorethe fracture situation during the operation, guide the reduction of the fracture, and accurately show the position of the ulnar nerve, effectively improve the safety of the medial puncture, so as to minimize the complications The occurrence of the disease. Therefore, the treatment of displaced supracondylar fracture of humerus with ultrasound-guided manual reduction and percutaneous cross needle fixation is effective and worthy of further promotion.

Child , Female , Humans , Humeral Fractures/surgery , Humerus , Male , Retrospective Studies , Ultrasonography , Ultrasonography, Interventional
Article in Chinese | WPRIM | ID: wpr-879321


OBJECTIVE@#To explore clinical effects of micro external fixator for the treatment of supracondylar fracture of humerus in children.@*METHODS@#From October 2017 to December 2018, 20 children with supracondylar fracture of humerus (treatment group) were admitted and treated with micro-external fixation after closed reduction, including 14 males and 6 females, aged from 6 to 14 years old with an average of (7.9±2.4) years old, classified to Gartland Ⅲ. Thirty nine children with supracondylar fracture of humerus were admitted as control group from January 2015 to September 2017, and treated with closed reduction Kirschner wire fixation. Among them, including 24 males and 15 females, aged from 6 to 14 years old with an average of (8.1±1.9) years old, classified to GartlandⅢ. Operation time, times of intraoperative fluoroscopy, and complications between two groups were observed and compared, Mayo scoring system at the latest follow up was used to evaluate clinical effect.@*RESULTS@#Twenty children in treatment group were followed up from 6 to 12 months with an average of (8.0±2.5) months, operation time was(30.10±12.50) min, times of intraoperative fluoroscopy was(10.00±2.50). Fifteen patients got excellent results, 3 good, 2 fair according to Mayo elbow joint scoring. No ulnar nerve injury moderate or severe elbow varus occurred in treatment group. Thirty-nine children in control group were followed up from 5 to 13 months with an average of (9.0±3.1) months, operation time was(45.60±18.90) min, times of intraoperative fluoroscopy was(19.00±5.60). Twenty-three patients got excellent results, 12 good, 3 fair and 1 poor according to Mayo elbow joint scoring. One child occurred ulnar nerve injury and recovered at the final follow-up, 1 child occurred severe cubitus varus and 2 children occurred moderate cubitus varus. There was no statistical difference in clinical effect between two groups (@*CONCLUSION@#Treated with closedreduction and mini external fixator fixed on children humerus condyle fracture could receive the same clinical result as closed as reduction gram needle fixation, which has advantages of shorter operation time, less times of intraoperative fluoroscopy, not esay to damage ulnar nerve during operation, less incidence of moderate and severe cubitus varus deformity after operation, and the permeation was simple.

Adolescent , Case-Control Studies , Child , Child, Preschool , External Fixators , Female , Fracture Fixation, Internal , Humans , Humeral Fractures/surgery , Humerus , Male
Article in Chinese | WPRIM | ID: wpr-879320


OBJECTIVE@#To compare clinical effect of Kirschner wire radial sector fixation and bilateral ulnar radial cross fixation in treating supracondylar fracture of humerus in children after closed reduction.@*METHODS@#From March 2017 to December 2018, 60 children with supracondylar fracture of humerus treated with closed reduction and Kirschner wire fixation were analyzed retrospectively, and divided into two groups according to different needling methods. Thirty patients in radial three needles fan fixation group (group A), including 19 males and 11 females, aged from 2 to 10 years old with an average of (5.00±2.10) years old, 21 patients were typeⅡ and 9 patients were typeⅢ according to Gartland classification. Thirty patients in cross fixationwith 3 needles on both ulnar and radial side group(group B), including 22 males and 8 females, aged from 1 to 9 years old with an average of(5.13±2.08) years old, 19 patients were typeⅡand 11 patients were typeⅢ. Healing time of fracture, postoperative complications, elbow flexion and extension activity, forearm rotation activity recovery, elbow carrying angle and angle loss after operation between two groups were observed and compared. Mayo Elbow function score at the final following up was used to evaluate clinical efficacy.@*RESULTS@#All patients were followed up, while there were no significant difference in follow-up time and fracture healing time between two groups (@*CONCLUSION@#Closed reduction and Kirschner wire at the early stage of fracture has advantages of less trauma, easy reduction, stable fixation, and early functional exercise. The risk of iatrogenic ulnar nerve injury caused by fan-shaped fixation of three radial needles is less than that of cross fixation of three radial needles.

Bone Wires , Child , Child, Preschool , Female , Humans , Humeral Fractures/surgery , Humerus/surgery , Infant , Male , Range of Motion, Articular , Retrospective Studies
Rev. chil. ortop. traumatol ; 61(3): 108-111, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1177822


El carcinoma de células renales es el 7mo cáncer en frecuencia a nivel mundial con más de 300.000 casos nuevos al año y es la 3era malignidad genitourinaria más frecuente. El sitio más común de metástasis es el pulmón mientras que el esqueleto ocupa el segundo lugar con una frecuencia que varía entre un 20% a un 35%. Se ha reportado una sobrevida de 12 meses en promedio luego de la aparición de metástasis óseas. Reporte del caso de un paciente con diagnóstico de cáncer renal de células claras y metástasis óseas (en columna, pelvis y ambos húmeros), que evoluciona con fractura de ambos brazos. El paciente es aceptado en un ensayo clínico de tratamiento con inmunoterapia y además se somete a una reducción y osteosíntesis bilateral de húmero con clavo endomedular, logrando la consolidación de ambas fracturas y, por ende, la regresión de la enfermedad.

Renal cell carcinoma is ranked 7th in frequent cancer worldwide with more than 3000.000 new cases per year, as well as it's ranked 3rd in frequent genitourinary malignancy. The most common area of metastases is lung followed by skeleton in second place. The frequency of skeleton metastases varies from 20% to 35%. A survival average time of 12 months is generally observed after the appearance of bone metastases. This case report is about a patient diagnosed with clear cell renal cancer and bone metastases (in the spine, pelvis and both humerus) that evolves with fracture of both arms. The patient undergoes a clinical trial with immunotherapy and also a reduction and osteosynthesis of both arms with intramedullary nail, achieving consolidation of both fractures and regression of the disease.

Humans , Male , Middle Aged , Bone Neoplasms/secondary , Carcinoma, Renal Cell/secondary , Humeral Fractures/etiology , Kidney Neoplasms/pathology , Bone Neoplasms/complications , Carcinoma, Renal Cell/complications , Carcinoma, Renal Cell/therapy , Fracture Fixation, Internal , Humeral Fractures/surgery , Humeral Fractures/diagnostic imaging , Immunotherapy , Kidney Neoplasms/therapy
Acta ortop. mex ; 33(5): 329-332, sep.-oct. 2019. graf
Article in Spanish | LILACS | ID: biblio-1284966


Resumen: Las fracturas de codo son secundarias a traumatismos de baja y alta energía, afectan el extremo distal del húmero, olécranon, cabeza radial o una combinación de las anteriores. Las fracturas complejas de codo dificultan la reducción y su posterior fijación, lo que representa un reto para el ortopedista. Es esencial el uso de auxiliares diagnósticos como la tomografía axial computarizada para su diagnóstico y posterior tratamiento. En la actualidad, las nuevas tendencias en la fijación de las mismas y los diversos implantes con los que se cuenta pueden mejorar el pronóstico del paciente. Se presentan dos casos clínicos de fracturas complejas de codo tratadas mediante osteosíntesis.

Abstract: Elbow fractures are secondary to low or high energy trauma affecting the distal humerus, olecranon, radial head or a combination of the above. Complex fractures of the elbow complicate the reduction and its subsequent fixation representing a real challenge for the orthopedic surgeon. It is essential the use of diagnostic aids such as computerized axial tomography for diagnosis and subsequent treatment. Currently new trends in the fixation of the same and the various implants with which it is counted, can improve improve the patient's prognosis. We present two clinical cases of complex elbow fractures treated by osteosynthesis.

Humans , Elbow Joint/injuries , Olecranon Process , Humeral Fractures/surgery , Range of Motion, Articular , Treatment Outcome , Elbow , Fracture Fixation, Internal
Acta ortop. mex ; 33(4): 252-255, jul.-ago. 2019. graf
Article in Spanish | LILACS | ID: biblio-1284949


Resumen: Introducción: Las fracturas de húmero distal en el adulto mayor constituyen un desafío terapéutico para ortopedistas, debido a las condiciones fisiológicas y los cambios óseos propios de esta edad. Reporte de caso: Se presenta el caso de una mujer de 80 años con osteopenia, quien sufrió una caída de su propia altura con fractura de húmero distal derecho, inicialmente se le dio manejo conservador, pero debido al desarrollo de seudoartrosis, se decidió hacer una artroplastía total de codo, con buenos resultados funcionales en el seguimiento postoperatorio a cuatro años. Discusión: En las fracturas de húmero distal, el manejo no quirúrgico es una opción en pacientes con baja demanda funcional o que tengan un mal estado general, y si no es el caso o fracasa el manejo conservador, deben ser llevados a artroplastía total de codo, ya que ésta proporciona una rápida recuperación del paciente en comparación con la reducción abierta y el manejo con material de osteosíntesis.

Abstract: Introduction: Distal humeral fractures in the elderly patient are a therapeutic challenge for orthopaedists, because of age's characteristic physiological conditions and bone changes. Case report: We present the case of an 80-year-old woman with osteopenia, who had distal humeral fracture due to a fall from her own height; she was initially treated conservatively, but by the reason of a non-union, we decided to perform a total elbow arthroplasty, achieving a positive functional result in the four years of postoperative follow-up. Discussion: Nonsurgical management is an option for treat humeral fractures in patients with low functional demands or in poor general condition. If the patient does not present the conditions above, or if nonsurgical management fails, a total elbow arthroplasty must be performed, because this method provides a rapid recovering if compared to an open reduction and osteosynthesis material management.

Humans , Female , Aged, 80 and over , Pseudarthrosis/surgery , Elbow Joint , Arthroplasty, Replacement, Elbow , Humeral Fractures/surgery , Treatment Outcome , Elbow , Fracture Fixation, Internal
Rev. Asoc. Argent. Ortop. Traumatol ; 84(2): 90-98, jun. 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1003016


Objetivo: Comunicar la eficacia del clavo endomedular recubierto con antibiótico (CERA) para erradicar la infección en la seudoartrosis infectada de húmero (SIH). Materiales y Métodos: Once pacientes (edad promedio 48 años). El tiempo entre la fractura y la cirugía fue 25 meses. El CERA se impregnó con vancomicina en 9 pacientes. El seguimiento promedio fue de 54 meses. Resultados: Se aisló S. aureus resistente a meticilina (SARM) en 5 pacientes. Todos recibieron antibióticos sistémicos por 7 semanas. El antibiótico más utilizado fue vancomicina. La mediana entre el primer tiempo quirúrgico y la reconstrucción fue 56 días (RIC 47-98). Luego del desbridamiento quirúrgico del primer tiempo, se midió el defecto óseo remanente y se lo dividió con variables dicotómicas: grupo con defectos <2 cm (7 pacientes) y grupo con defectos ≥2 cm (4 pacientes). No se observaron diferencias significativas entre la mediana de días entre el primero y segundo tiempo quirúrgico comparando el desarrollo de SARM con el de otros gérmenes (48 días [RIC 45-75] vs. 73,5 días [RIC 56-149], p = 0,2002 Mann-Whitney), ni en la proporción del tamaño del defecto óseo según el desarrollo de SARM o de otro germen (60% vs. 17%, p = 0,242 Fisher). Todos los cultivos fueron negativos y se logró la consolidación del foco fracturario, sin recurrencia de la infección. Conclusiones: El CERA es una buena opción terapéutica en el primer tiempo quirúrgico para un paciente con SIH. Se pudo controlar la infección, lo que permitió la reconstrucción secundaria de la seudoartrosis. Nivel de Evidencia: IV

Objective: To evaluate the efficiency of the antibiotic cement-coated rods (ACCR) to erradicate infections in infected nonunion of the humerus (INH). Methods: We included 11 patients with INH with a mean age of 48 years. The time from fracture to surgery was 25 months. The ACCR was impregnated with vancomycin in 9 of 11 cases. Follow-up was 54 months. Results: Methicillinresistant Staphylococcus aureus (MRSA) was isolated in 5 cases. All patients received systemic antibiotic treatment for 7 weeks. Vancomycin was the most commonly used antibiotic. Time from ACCR placement to reconstructive surgery averaged 56 days [confidence interval range (CIR) 47-98]. After debridement and implant removal, the residual deformity of the nonunion was measured with dichotomous variables and classified into two groups: group 1, <2 cm (7 patients) and group 2, ≥2 cm (4 patients). No significant differences were observed between the number of days from placement of the ACCR to the development of the MRSA infection, compared to other pathogens [48 days (CIR 45-75) vs. 73 days (CIR 56-149) p=0.2002, Mann-Whitney U test], nor were differences observed in the size of the defect in those who developed MRSA or by any other pathogen (p=0.242, Fisher exact test). Reconstruction was performed with different techniques. Laboratory parameters were normal and cultures were negative. Fractures achieved consolidation without recurrence of the infection. Conclusions: ACCRs are an adequate treatment option for patients with an INH. The infection was controlled in all cases, which allowed for the secondary reconstruction of the nonunion. Level of Evidence: IV

Adult , Middle Aged , Pseudarthrosis , Fracture Fixation, Intramedullary/methods , Humeral Fractures/surgery , Infections , Treatment Outcome
Rev. Assoc. Med. Bras. (1992) ; 65(3): 355-360, Mar. 2019. graf
Article in English | LILACS | ID: biblio-1003039


SUMMARY OBJECT: To explore the treatment effect of the anterior medial neurovascular interval approach to coronal shear fractures of the distal humerus. METHODS: This prospective study included two female patients who were 30-64 years old, with a mean age of 47 years. Fractures were caused by falling from a bicycle. The time between the injury and operation was 1-2 days, with a mean time interval of 1.5 days. Two patients with coronal shear fracture of the distal humerus were treated with open reduction and internal fixation using anterior neurovascular interval approach. RESULTS: There were no intraoperative and postoperative neurological and vascular complications or infections, and the fracture was united. At 12 months after the surgery, the patient returned to work without pain, and with a normal range of motion for elbow and forearm rotation. The X-rays revealed excellent fracture union, no signs of heterotopic ossification, and no traumatic arthritis. According to Mayo's evaluation standards for elbow function, a score of 100 is excellent. CONCLUSIONS: The application of the anterior neurovascular interval approach of the elbow in the treatment of shear fracture of the articular surface of the distal humerus, particularly the trochlea of the humerus, can reduce the stripping of the soft tissue.

RESUMO OBJETIVO: Explorar o efeito do tratamento com uma abordagem anterior do intervalo neurovascular médio para fraturas de cisalhamento coronal da porção distal do úmero. METODOLOGIA: Este estudo prospectivo incluiu duas pacientes do sexo feminino de 30-64 anos de idade, com idade média de 47 anos. As fraturas foram causadas por quedas de bicicleta. O tempo entre a lesão e a operação foi de 1-2 dias, com um intervalo de tempo médio de 1,5 dias. Duas pacientes com cisalhamento coronal da porção distal do úmero foram tratadas com redução aberta e fixação interna utilizando a abordagem anterior do intervalo neurovascular. RESULTADOS: Não houve complicações neurológicas e vasculares intra e pós-operatórias, nem complicações ou infecções, e a fratura foi unida. Após 12 meses da cirurgia, as pacientes retornaram ao trabalho sem dor e com uma amplitude normal de movimento de rotação do antebraço e cotovelo. Os raios-X revelaram excelente união das fraturas, sem sinais de ossificação heterotópica e sem artrite traumática. De acordo com as diretrizes da clínica Mayo para avaliação da função do cotovelo, uma pontuação de 100 é considerada excelente. CONCLUSÃO: A aplicação da abordagem anterior do intervalo neurovascular do cotovelo no tratamento de uma fratura de cisalhamento da superfície articular da porção distal do úmero, especificamente da tróclea do úmero, pode reduzir o desgaste do tecido mole.

Humans , Female , Adult , Vascular Surgical Procedures/methods , Neurosurgical Procedures/methods , Elbow Joint/surgery , Fracture Fixation, Internal/methods , Humeral Fractures/surgery , Humerus/injuries , Time Factors , Prospective Studies , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Humeral Fractures/physiopathology , Humerus/physiopathology , Medical Illustration , Middle Aged
Acta ortop. mex ; 33(1): 36-38, ene.-feb. 2019. tab
Article in Spanish | LILACS | ID: biblio-1248630


Resumen: Objetivo: El propósito de este estudio es investigar el impacto clínico en la función global en el hombro intervenido para el abordaje anterolateral de enclavado centromedular de húmero. Material y métodos: Se trata de una cohorte retrospectiva de casos tratados entre 2011 y 2016. Como criterio de inclusión se revisó todo paciente con antecedente de enclavado de húmero con abordaje anterolateral. Se realizó una evaluación con la escala funcional de Constant-Murley, arquimetría comparativa de ambos hombros y la aplicación de cuestionario quick DASH. Resultados: Se obtuvieron 17 pacientes, 16 tratados para fracturas diafisarias de húmero y uno para displasia fibrosa de húmero. El puntaje promedio de la escala de Constant-Murley obtenido fue de 84.05, 76.4% de los pacientes obtuvieron excelentes resultados (> 75 puntos). Un paciente tuvo un resultado funcional deficiente. El puntaje promedio de quick DASH obtenido fue de 17.5 puntos. Conclusiones: El abordaje anterolateral para enclavado centromedular de húmero tiene buen pronóstico funcional en nuestra serie de casos.

Abstract: Purpose: The purpose of this study was to investigate the clinical impact on the global function of the shoulder of the use of the anterolateral approach for nailing. Material and methods: A retrospective cohort at the public sector of Centenario Hospital Miguel Hidalgo in Aguascalientes, Mexico between 2011 and 2016 was analysed. Inclusion criteria were: patients with anterolateral humeral nailing approach. Clinical assessment using the Constant-Murley score, shoulder range of motion and quick DASH questionnaire. Results: Seventeen patients, 16 treated for humeral shaft fracture and one for humeral fibrous dyslasia were obtained. Mean score on Constant-Murley scale was 84.05 with 76.4% of patients achieving excellent result (> 75 points). One patient had a poor functional outcome. The mean quickDASH score was 17.5 points. Conclusions: The anterolateral approach for humeral nailing has good functional outcome in our series.

Humans , Fracture Fixation, Intramedullary , Humeral Fractures/surgery , Bone Nails , Retrospective Studies , Treatment Outcome , Humerus , Mexico
J. health med. sci. (Print) ; 5(1): 61-66, Ene-Mar. 2019. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1151902


La reducción cerrada y la fijación percutánea ha sido el gold standard para las fracturas supracondíleas de Gartland tipo II y III. La técnica de enclavado percutáneo transfocal endomedular (TEPTE) ha surgido como alternativa quirúrgica con los beneficios de no lesionar nervios importantes en la región del codo. El objetivo del presente estudio fue comparar los resultados funcionales y estéticos de niños con diagnóstico de fracturas supracondíleas de húmero Gartland tipo II y III, tratados con la TEPTE y la técnica de fijación cruzada (TFC). Se realizó un estudio retrospectivo, observacional, transversal, durante los meses de enero de 2017 a mayo de 2018 de niños con fracturas supracondíleas, tratados con el TEPTE (grupo uno) y TFC (grupo dos). Evaluamos la funcionalidad y la deformación mediante la escala de Flynn. Para el análisis estadístico, se utilizó el test Mann-Whitney para muestras independientes en el programa SPSS. Fue considerado como significativo valores de como p ≤ 0,05. Los resultados demostraron un valor de 4,500 con un p = 0,000, evidenciando diferencias significativas entre los resultados de ambas técnicas respecto a la perdida de movilidad y el ángulo de transporte, a favor de la TFC.

Closed reduction and percutaneous fixation has been the gold standard for Gartland supracondylar fractures type II and III. Percutaneous transfocal intramedullary nailing (TEPTE) has emerged as a surgical alternative with the benefits of not damaging important nerves. The aim of the present study is to compare the functional and aesthetic results of children diagnosed with Gartland humerus supracondylar fractures type II and III, treated with TEPTE and crossed fixation. A retrospective, observational, transverse cohort study was conducted during the months of January 2017 to May 2018 of children with supracondylar fractures, treated with TEPTE (group 1) and cross-fixation (group 2). We evaluate functionality and deformation using the Flynn Scale. For statistical analysis, the Mann-Whitney test was used for independent samples in the SPSS program. Values of p ≤ 0.05 were considered significant. The results showed a value of 4,500 with a p = 0.000, as p≤0.05, it indicates that there are significant differences between the results of both techniques, for the loss of mobility and the transport angle, in favor of the crossed technique, so that we conclude not TEPTE about crosslinking.

Humans , Male , Female , Child, Preschool , Child , Fracture Fixation, Internal/instrumentation , Humeral Fractures/surgery , Fluoroscopy/methods , Cross-Sectional Studies , Retrospective Studies , Follow-Up Studies , Ecuador , Fracture Fixation, Internal/methods , Humeral Fractures/diagnostic imaging , Humerus